HomeMy WebLinkAboutBLD2025-00541 - BLD CD Environmental Health Review - 5/6/2025 Zoho Sign Document ID:333558B4-MXNYP76WDJO8RO8URV8ZPJXYBYCJGBVW2TBC6N1SXVU
i
s MASON COUNTY Permit No: ��(�o vo ''(
'' COMMUNITY DEVELOPMENT RECEIVEDm n
ty1AY D 2 2U2�
ti'�'1 Permit Assistance Center,Building,Planning TTl ., ;n
7.4 rnii
BUILDING PERMIT APPLICATION 615 W. Alder Skeet
PROPERTY-- OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: L V.-Sam;._ a NAMEV;Af.A \&CA?Jett stvkle. NLI LE-i—
MAIL�IG ADDRESS: II Itr i i4 MAILING ADDRESSJLO W K t1 54— C.. m
CITY:\ .LO4.0-14• STATE:t- ZIP:4ZgZf. CITY:Skt)�� STATE:t.JA ZIP: 4Ss$� Z
PHONE#I:� 1-00 PHONE: 400"1B0.94CCELL:
PHONE#2:4-L Si EMAIL: ''�1 \�-p"N•W�
EMAIL:?krsi..as.- ,LIG •t61,..N, L&I REG# 1 EXP.(,6 /11IV
PRIMARY CONTACT: OWNER❑ CONTRACTOR 1 OT R❑ m 0
NAME-0Qmt.4-1 b st-k �.4,.wad� EMAILS ______ a�.` 1.L.a>� Z
MAILING ADDRESS t.0 1.3 .V S4 Si. C.. CITY STATE ZIP __
O r
PHONE 340-? J"3S CELL •---} K
PARCEL INFORMATION: = Z
PARCEL NUMBER(12 Digit Number)32.bQ 3-04r03 1 S ZONING
LEGAL DESCRIPTION(Abbreviatcd),Aj L�,f+t'et1ie.i, Mai ai 14..e-A' 3I&y L.•4 WIRE DISTRICT
SITE ADDRESS l tb e 3 n CITY s(o,.11l Imo- r
DIRECTIONS TO SITE ADDRESS
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 13%: YES❑ NO jSNOW LOADX r psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all tharappivi
SALTWATER 0 LAKE❑ RIVER/CREEK❑ POND 0 WETLAND 0 SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEW Er ADDITION 0 ALTERATION 0 REPAIR❑ OTHER 0
USE OF STRUCTURE(Resaenrc Garuge.G>.nmeroul Ally.Etc.) IZeicu t M l.wj&U.. C ZJLE.t te-1
IS USE: PRIMARY 0 SEASONAL 0 NUMBER OF BEDROOMS_7 NUMBER OF BATHROOMS_.___
HEATED STRUCTURE? YES ef1rolr Bldg)0 YES(Panls'ofBldg)❑ NO❑
DESCRIBE WORK ifsibigtteLStC' S+ys• �-k.-
SQUARE FOOTAGE:tpropocedl 91# KIV W�((
I ST FLOOR sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.R.
DECK sq.ft. COVERED DECK sq.ft. STORAGE sq.ft.'OTHER,2,CIO sq.ft.
GARAGE sq.ft. Attached❑ Detached 0 CARPORT sq.ft. Attached❑ Detached 0
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC 0 SEWER❑ / NEW 0 EXISTING 0
PLUMBING IN STRUCTURE? YES 0 NO ElIfyes.attach completed Water Adequacy Form
NO❑ EXISTING SQ.FT.
PERIMETER/FOUNDATION DRAINS PROPOSED'? YES❑
EXISTING BEDROOMS PROPOSED BEDROOMS TOTAL BEDROOMS
OWNER acknowledges that submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such Is by
signature below.I declare;hat I am the owner and I further declare that I am entitled to receive this permit and to do the work as proposed.I have
obtained permission from a)the necessary parties.including any easement holder or parties of interest regarding this project. The owner or legal
4' representative.represents that the information provided is accurate and grants employees of Mason County access to the above described properly
and slructure(s)for review and inspection. This permitiapplicauon becomes null&void if work or authorized construction is not commenced within 1130
days or if construction work is suspended for a period of 180 days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
X 1''\L' ,tAen. 04/28/25
Signature f OWNER(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT _
PLANNING DEPARTMENT
FIRE MARSHAL 0 PUBLIC HEALTH Or 6(4(4 Covkikiiti QI j&l
E
pp E EE I
=s l-.-1
i
�� e,
J
O z
...
O a0
_ iiII1iI ! I : i j N
° zF aa).,ip N z 3
ai wtsi i I� <m 8
gel w
11;
a �$ 411g Wz i eLtd
d �p5 g <: i Qi l i _ r 1 I ® W
Kg s ® - J ® 1 I
•„u6!sa0 s)IJoM a6emas JOd eual!J).300 aql 10 6-1D t
uo!pas My'palan.asuop Si au!'ayl pue JaD!go ylledq leDoi a41 Aq panoidde
;i aull A1ddns Jalem e;o,pl u!yl!m aq Apo cew au!1 uodsueal camas(3
ease anrasai/pla!;u!eip;o lua!peJ6-umop lice i
T ,0S u!yl!m(saaj6ap St?Jano 79,5 uein ia)eaJ6)(s)lueq'(s)lnp ON(0
o ease aniasai big
to 3 /pla!;u!eap Jo lua!pea6-umop.0E u!yi!m su!eip Jalawuad/uo!iepuno;oN(D l ;
suo!lepuno;/6u!loo;lie wo.l;pews,5 sannbai(s)>luel 3gdaS(8
w suo!lepuno;/6u!loo;wail)peglas,pi,saj!nbai anlasaa/plaIu!eJ0(V e
E SNJd813S H3 -J/� W
d szozno'90 .� a V Z
03AOMddy H3 W w =
l ,,s- yl _ - II 0
• 1m,,,,,,, - - �
03- nyfinvorriPrik\ E -----
.4CP 1
$ llialz .c'
h
J 3 -3 - - - 42 HwE,
5111
Z e3 F. _R' it' ♦j- N _ W R-
n;" . R
c _ S p
2s } ----- icy`u�". `° aii
.'' 4 d m y 3
.cUl / 1 C<N p-
°) E73 E
2 •O 0.• a l0 U
z zs 01 7 O
g cc0
to =� 2
O wU y,;' c o5 ta c
N >• 0 iy Ncsa 4
• az oar ;<. Ma c WA R 111111
fig
in aU - ,.. ` O >.y C1 if s
O E° EcE
z
O • 0/ N._• tom
a y Z R a� ,� o
m Owamm
)tor.!